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Monday, April 10, 2017

couples matching: how we went about this crazy process

Alright! So this post is like three weeks overdue from when I promised I'd write about the couples match and how we approached this process, but as it turns out, it takes a lot longer to write out everything we did over a 14 month process!

So, as a background, for medical students to be accepted into a residency program (where they receive the training in whatever field they go into - for me it's obstetrics and gynecology), they have to go through a process called "The Match". Long long story short, we apply to as many programs as we want, are offered interviews to residency programs based on our application, submit a rank order list at the end of the season, and then an algorithm figures out where everyone goes based on the applicants' and programs' lists. This video explains how that algorithm works so much better than I ever could - it even won a Nobel prize in Economics! The match is not a perfect system, but I do believe it probably makes this process as fair as possible.

So the nice thing is that the NRMP has what is known as The Couples Match. It's the exact same as the normal match, but is complicated because you and your rank list are tied to another person. Watch this video to see how the algorithm manages that situation. The fun thing about the couples match is that you can couples match with anyone! I know best friends, cousins, and siblings who have gone through the couples match, as well as people who are dating, engaged, or married.

Okay, so now with that background, here is how CR and I went about this process.BEGINNING OF THIRD YEAR: DECIDING TO COUPLES MATCH
We started living together in June of 2015, the beginning of our third year of medical school. We were happy and committed and knew that we wanted to "spend our lives together", so we basically always knew that we were going to go into the match together. I think it's super important to be very open about your expectations, wishes, and dreams about your own future, your futures together, and what you want in your own careers. CR basically always knew he wanted to do family medicine, and I discovered pretty early on in third year that I wanted to do ObGyn. We were both lucky that we wanted similar things in our perspective residency programs: we didn't have aspirations to go to huge academic centers, we weren't set on only going to one city specifically, and we knew that since I was going into a medium-competitive speciality, we would have to be flexible.

DECEMBER-FEBRUARY OF THIRD YEAR: RESEARCH POTENTIAL PROGRAMS
Starting in December of our third year, we started compiling our list of potential residencies. We used Freida to pull the lists of all the family medicine and obgyn residents in the states we were applying to - we decided we were going to apply to places in the Great Lakes region, so Wisconsin (where I'm originally from), Michigan, Ohio (where we currently live), Pennsylvania, upstate New York (where CR is from), West Virginia, and North Carolina (not so Great Lakes region, but warm weather seemed appealing at the time). We each pulled our lists up, and then made a combined list. There are less ObGyn residencies than Family Medicine, so I literally read the city that the ObGyn residencies were in, and then CR deleted all the programs that weren't in that city. In the end, that gave us 70 total programs to apply to - 50 for me, with 20 more Family Medicine programs in the same cities for CR. We added all of these to a shared google document so we could both work on it together.

Next, we started gathering data on each program. Again we used FREIDA for some of the data - mostly how many residents they take each year and what board scores they use as cut offs for interviews (although those aren't super accurate - for example, what ended up being our second choice program had a cut off that I was below, but I was still interviewed!). Then we went to each residency's website to look up more information. A big one for us was how many DOs there were at each program. Since we were DO students applying to the "MD" match, it was important that we were realistic about our applications and limitations. If a program only has 1 DO out of 20, chances are they aren't super "DO friendly". This is important because you have to apply for the best programs for you as an applicant. Applying to residency programs is expensive, so if you have the cash to apply to all ~200 (which would be like...$4000), I suppose go ahead, but we paid for this process ourselves, and wanted to be smart applicants. We also looked up information about the hospital - how many beds it has, what level NICU does it have (a huge point for me), is it a trauma center (big for CR's training), what kind of city is the hospital in, and so on.

Once we had that information listed, we color coordinated all of the programs. Ones that were big reaches for us where colored red, ones that we felt were a good fit for us (both us as applicants and programs that we were interested in) were green, and ones that we were unsure of for one reason or another (super undesirable location, or some other factor that made us weary) were colored yellow.

FEBRUARY - MAY OF THIRD YEAR: APPLY FOR AUDITION ROTATIONS + LoR

This is the time when we started to think about applying for audition rotations. This very much depends on what speciality you are going in to - typically, surgically specialities require auditions more than clinic based, but this very much varies. We both knew that we would be doing audition rotations - me more because I had to, and CR more because he wanted to spend time at possible future programs and to give us the best chances of going somewhere together. We basically applied to all of the green programs on our list - some were through VSAS, some were through online applications, and other were just emailing program coordinators. It's quite an extensive process that involves filling out a lot of forms, writing and following up on emails, and scheduling headaches. In the end, we both ended up doing three auditions. Two of each of ours was at the same hospital - we had both previously heard good things about the individual programs, and felt like if we both went to those programs, it would give us the greatest chance of matching there as we could say we were both very interested in the program given our time rotated through it.

During this time is also when we started asking and collecting letters of recommendation. I had two ObGyns and one IM doctor write mine. Ideally have a program director write it, but sometimes it means more to have a really personal letter about you from an attending rather than a generic letter from a program director (at least in my experience - I was told at multiple interviews how glowing my letters of recommendation were, and I think that carried a lot of weight).

JULY - SEPTEMBER OF FOURTH YEAR: GO ON AUDITION ROTATIONS
This is when we started our audition rotations. Our schedule worked out that one of us was always on an audition and one of us was always home, which was really convenient since we have three animals at home! During this time is really the time for you to shine at the programs you are visiting. How to do that really varies by which speciality you are applying to, but for ObGyn, here are a few things I did:

Pre-rounded before the intern got there. Since the interns got to work around 4:15 AM, I would get there around 3:45 AM to see my patients and write my notes.

See patients and triage and write notes as quickly as possible. It's all about being pro-active, so if you need to hunt down prenatal paperwork to complete your note, it looks good to have that before you present to the resident/attending. It's important to get a detailed birth history (after all, that's 50% of what you do as an ObGyn!)

Help in the OR by grabbing your own gown and gloves, helping move the patient, grabbing warm towels and sterile water, and helping prep the patient. Plus you should know about the patient and their procedure - what does previous pathology show, why are they having this procedure done, what are the indications and steps for the surgery?

General surgery things: know pelvic anatomy (especially blood supply), how to hand tie, and how to suture.

Get to know the residents as people instead of doctors. I was working 80 hours a week with these people, and I wanted to work with them for the next four years, so I made an effort to get to know them outside of just their role as doctor. A lot of this is just about being normal which is hard sometimes when you also want to prove you are smart and a hard worker.

Along with being on auditions, this is the time that we started to prepare our ERAS applications. ERAS is the system that takes all of your information and puts it into a universally formatted document. If you already have an updated CV, this is pretty straight forward to do.

The big thing is the personal statement. You guys, I hated writing my personal statement. For someone who likes to write, I struggled hard with this. I didn't want it to be a generic statement about how yay I love ObGyn and yay I'm so excited and yay I'm so good at women's health yay go me! So I went like the complete opposite and wrote about...I don't even remember exactly what I wrote about. But after I wrote my first draft, I had CR read it, and he basically said that while I can write about whatever I want, but that that personal statement didn't sell me at all, and it didn't sell why I was even applying for ObGyn. And what he said was so true. The personal statement is about selling yourself. Why are you a good fit for this speciality? What experiences have you had that let you do this point? Why do you want to dedicate yourself to this speciality? How have experiences in this profession changed you to be the person you are today? I know...this all sounds cheesy AF...but it's necessary! I've heard over and over again that for 90% of personal statements, as long as you are saying some nice things about the profession and about yourself, it doesn't make or break your application. But for 5% of people, their personal statement is so mind blowingly amazing that it really elevated their application, and for another 5%, it made such a bad impression that it affected them negatively (I personally know someone that this happened to a year ago, where after they didn't match, programs told them it because their personal statement didn't convince them of why they were even bothering to graduate from medical school. This year they wrote a much better, standard personal statement, and successfully matched at their top choice!). Basically, write your first personal statement, have someone read it (someone who knows about this process! Either an advisor or at least someone in your class you trust), and then rewrite, edit, revise, revisit, and then rewrite it again. I had another three people read mine until I felt it was good enough to submit. It's definitely a process that takes a while, so don't wait until ERAS opens to start writing!

SEPTEMBER OF FOURTH YEAR: OFFICIALLY APPLY TO PROGRAMS

ERAS officially opens for you to apply to programs around the middle of the month (I think exact dates change every year - this was last year's schedule). They have made it so that ERAS opens a week before you apply, so the system doesn't crash when thousands of medical students try to log on. So this is when you pick out what programs you want to apply to, and pay for the application. Finalize your list with your partner, and double check you both have all the right programs. One week later is when all completed applications are sent to residency programs. My big piece of advice is make sure you have your application completed, uploaded, and programs applied on the date that the program can first download the applications. Some programs will only download applications one time, and you don't want to waste your time and money applying to programs that won't even look at your application.

SEPTEMBER - JANUARY OF FOURTH YEAR: GO ON INTERVIEWS
Interview invites and interviews is another situation that greatly varies by speciality. I would check out the NRMP Program Director's survey to see the specifics about how your speciality handles interviews (the last section of each speciality shows you what months they typically send out invites and do the interviews). Some programs, like FM and IM, tend to interview early, while others like derm and plastics are way late in the season (for example, read Joyce's experience with applying to dermatology residencies). Don't freak out, don't stalk SDN, and don't constantly compare yourself to others. You may find that your friends start to keep to themselves a bit more. My three besties and I text every single day, but once ERAS opened, we got pretty quiet about applications and interviews. It's a tense time, especially if you have friends applying to the same specialty. Or if you are dating a rockstar, and everyone in the Family Medicine world wants to interview him, and you're over here like "please love me, ObGyn programs, please".
Okay, so for the couple's match specifically, this is how we handled interview invites.

Say that I got an email from a program offering me an interview. I would respond back basically immediately to book my interview date, and then I would mention that "I'm participating in the couples match with my partner *insert name here*, who is applying to your *their speciality here* program, and has not been invited for an interview yet. We are both very excited about the prospect about coming to *insert hospital here*". This again will vary by speciality and programs, but for us, the program coordinator of my program (in this example) would contact CR's program's coordinator, and then they were more inclined to look at his application to see if they would interview him. I think this really benefitted me in this process. When programs typically receive 100 times the amount of applications that they have spots for. Then they interview about 10 times the amount of people for the amount of spots. So, for example, my program received around 400 applications for its 4 spots, and interviewed 40 people. To get through all of those applications, they will initially filter out people based on their chosen criteria (usually Step scores and any red flags). Then they have a group of people they for sure know they are going to interview (rockstars, people from their own schools, people auditioning), and then everyone else who made it past the screen. I was probably in this middle group for a lot of programs. So when they were forced to look at my application because CR's program coordinator mentioned me, I got interviews. I think this is one of the biggest ways that couples matching can help your application. I should put a disclaimer there that we ended up matching at different hospitals, so this process didn't even make a difference for us (in the end, now that we know the outcome), but it did get us more interviews, and as the data shows, the more interviews you have, the higher chance you have of matching.

So as soon as I scheduled my interview with the program, I would go highlight that program on our Google Document, and then write when my interview was. I would also add it to our shared Google calendar. That calendar ended up being so helpful, since we could always see our schedules just by looking at our phones, and so we could coordinate those busy busy months. Communication and organizing is key!

So say I have an interview, I mentioned to my coordinator that I'm couple's matching, but CR still hasn't heard anything from his program. About 2-3 weeks after I received my invite, CR would email his coordinator and "follow up" on his application as "he is couples matching, and his partner has an interview with the ObGyn department, and we both are very interested in that hospital". This again will maybe get them to look at your application - we got at least two more interviews doing this!

So for the interviews themselves, we did not even bother to try to schedule any interviews together. Almost all of our hotels were comped by the programs, so while it would have been nice to travel together, we didn't try to add another complication to this already complicated scheduling mess.

Interviews are a unique experience. I had a lot of fun going on mine! Because we applied to one programs in one region, we drove to all of our interviews. Some of those would have been probably better to fly to (like the ones in Wisconsin - those ten hours of driving were killer), but in our situation, we were able to drive. I loved exploring the cities we were applying in, getting to know the residents and fellow applicants, and eat all the delicious food! It really is fun, but also stressful and lonely at times. Definitely make the most of it though - chances are you won't get as many hotel rooms and fancy dinners paid for in such a short amount of time any time soon!

After every interview, I would write a couple key points about each program down in our shared google document - things that I liked, things I didn't like, and where they kind of fell on my own list of programs. Once you start going to quite a few interviews, details start to mesh together, so while I can tell you exactly how I felt about each program while I was there, I couldn't tell you specifics that like how their holiday schedule works or if they have a true continuity clinic - that's why you write those things down so when you go about making your rank list four months later, you remember what you liked and didn't like.

MID FEBRUARY: RANK LISTS ARE DUE

Making a rank list is stressful on your own, but when you have to combine your wishes and dreams with someone else's...it can be a tense time! That's why again communication is key. Be honest about what you can and can not compromise on. Have long discussions about what why you want to go to certain place, but be flexible. Remember that if you are couples matching, you are making the decision to do this together, and sharing a life together isn't going to be any easier than making a rank list! For us, being flexible meant that while I would have loved for us to be at the same hospital, we both fell in love with programs at hospitals that were 20 minutes apart, so instead of me forcing him to rank a program he didn't love as much higher just because I would have liked to see him walking down the hallway once in a while, it means so much more that he's at program he truly loved (the first one he visited, and the one he compared every single interview to) but also close enough that we could still very easily live together.

Our system for making our rank list was pretty straightforward because the programs we interviewed at were so far apart (except our top choice) that we could only rank that hospital and no other combinations. For people who interview in big cities (like NYC) that have dozens of options, making a rank list can get really really complicated. Our final rank list had 14 full spots in it + 3 spots where CR matched and I didn't (his 3 programs we chose were in big cities where I was more likely to find a spot if I didn't match). There's a website that helps you make a rank list if you are in one of those situations where you could have literally hundreds of combinations (you are allowed to make up to 700 combinations).

Once you submit your final rank list, go out to dinner and drink a bottle of wine - there's nothing you can do to change the outcomes!

MARCH: CELEBRATE!

I was a nervous wreck the two weeks leading up to Match Week. I couldn't sleep, I couldn't concentrate, I was on edge the whole time. We knew CR was going to match - several programs had expressed a lot of interest, but the ObGyn world is a lot more tight lipped, so while I had received some reassurance, I wasn't going to not be nervous until I got the email. And when we got that "congratulations, you matched!" email, it was probably the second happiest moment of my entire life. The fact that I get to do the one thing I fell in love with in medical school, and to get to do it with the one man I fell in love while in medical school - it is just the best.

And that's how we couples matched. It was a long complicated journey, one that I'm so glad we never have to do again, but one that made us stronger as a couple.

And because everyone's path to residency is different, here are a few posts by some of my favorite bloggers that discuss their journeys, their failures and triumphs, and tips along the way: